Sample FOIA Request

PRIVACY ACT & FREEDOM OF INFORMATION ACT REQUEST (date)

(requester's name and address)
Federal Bureau of lnvestigation
Records Management Division - FOIA/PA Office
9th & Pennsylvania Avenue NW
Washington, DC 20535

Gentlemen:

This is a request for records under the provisions of both the Privacy Act (5 USC 552b) and the Freedom of Information Act (5 USC 522). This request is being made under both Acts.

I hereby request one copy of any and all records about me or referencing me maintained at the FBI. This includes (but should not be limited to) documents, reports, memoranda, letters, electronic files, database references, "do not file" files, photographs, audio tapes, videotapes, electronic or photographic surveillance, "june mail", mail covers, and other miscellaneous files, and index citations relating to me or referencing me in other files.

My full name is:___________________________________

My date of birth was______________

My place of birth was:______________________________

My social security #:______________

I have lived in these places:

Other names, places, events, organizations or other references under which you may find applicable records:

As you know, FOIA/PA regulations provide that even if some requested material is properly exempt from mandatory disclosure, all segregable portions must be released. If the requested material is released with deletions, I ask that each deletion be marked to indicate the exemption(s) being claimed to authorize each particular withholding. In addition, I ask that your agency exercise its discretion to release any records which may be technically exempt, but where withholding serves no important public interest.

I hereby agree to pay reasonable costs associated with this request up to a maximum of $25 without my additional approval. However, I strongly request a fee waiver because this is, in part, a Privacy Act request. This letter and my signature have been certified by a notary public as marked below.

Sincerely,

requester's signature

requester's printed name

notary stamp and signature